Many people with rheumatoid arthritis (RA) also have anemia. Learn what causes anemia and get tips for keeping it under control.

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Rheumatoid arthritis (RA) is an autoimmune disorder, which causes chronic inflammation of the joints. Besides joint pain, anemia is one of the most common symptoms of RA. In fact, anemia occurs in up to 60 percent of people with RA. Because anemia-related fatigue contributes to the debilitating nature of RA, it is especially important that anemia is recognized and addressed.

What Is Anemia?

Anemia is usually due to a decrease in the red blood cells in your body. Red blood cells are made up of hemoglobin, an iron-rich protein, which transports oxygen from the lungs to the rest of your body. In some cases, people with anemia actually have enough red blood cells, but these cells contain abnormal or insufficient hemoglobin.

If you do not have enough red blood cells or hemoglobin, your body’s organs do not get enough oxygen. When left untreated, anemia can cause fatigue and weakness. Other symptoms of anemia include headache, poor concentration, shortness of breath, and rapid heartbeat.

Why Do RA Patients Develop Anemia?

“The most common cause of anemia in RA patients is anemia of chronic illness," also known as anemia of chronic disease (ACD), explains Robert W. Lightfoot, MD, a professor of internal medicine in the division of rheumatology at the University of Kentucky in Lexington. “Anemia tends to occur in most chronic illnesses, which includes RA.”

The underlying causes of ACD are not well understood, but the inflammation that occurs throughout the body in RA may contribute to anemia. Inflamed tissues in the joints release proteins that impact the body's ability to use iron and produce red blood cells, leading to a low red blood count.

Medications commonly used to manage RA, including non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, may also promote the development of anemia. These drugs can cause chronic irritation and bleeding of the stomach lining. This blood loss may not be immediately apparent, but over time, it can lead to anemia.

How Can RA Patients Manage Anemia?

Injectable erythropoietin (a hormone involved in the production of red blood cells) is sometimes used to manage anemia in RA patients. “It stimulates the bone marrow to produce iron and helps increase the number of red blood cells, but the drug is expensive and the effect is minimal,” notes Dr. Lightfoot.

Iron therapy given by vein is often beneficial for RA patients with anemia who have low levels of iron in the blood. Even so, Lightfoot points out that anemia in RA patients typically doesn't respond well to standard treatments. As a result, "it is important to treat the [underlying] inflammation caused by the RA,” in order to manage anemia effectively in this population, says Lightfoot.

So keeping your RA symptoms under control is actually the best way to address your anemia. Managing the inflammation and swollen joints associated with RA, should help alleviate your anemia. An effective RA treatment regimen will improve both your joint symptoms and anemia, thereby enhancing your overall physical function.

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